28 comments:

You obviously left the magic wand at home. When people get angsty and want a diagnosis without any teting (how am I supposed to know exactly why your dog is vomiting anyway?), I offer the magic wand, which always costs more anyway. Or the magic 8 ball app on the phone.

I've tried 3 anticonvulsant medications for migraine prevention with little to no success. One of them (Topamax) caused horrific anger and confusion. Is it possible your patient is demonstrating irrational expectations because of the medication?I do empathize with your situation. I just wanted to explain that these meds can do some strange things to your personality.£eslie

I'm not sure, but I kinda sympathise with the patient on this one. Except maybe not the change medication-reaction, but if she (I'm just assuming it's a woman) have tried several without effect and is tired of trying new medications all the time I can see that, too.

Well, all in all I'm a bit in between parts on this one, I think it must be quite frustrating for her, too, but if it had been me I'd jump on the opportunity to go to Humungous Neurology.

How about recommending brain surgery? Really RADICAL brain surgery, like that procedure where they remove half your braina and leave one side of your body completely paralyzed? The meds might start sounding better in comparision!

It sounds like your patient watched way too much star trek when she was a kid. I have heard a few not too bright people saying they expected doctors to already have similar technologies in use just because they saw them on TV.

Granted, we are getting there but not yet... maybe not in my lifetime :-(

Ok, not to be snarky--but I deal with less connected people than you do--as in mentally ill and similar. So in the friendliest way possible, I suggest. 1. Meditation. 2. Cultivation of extreme patience 3. The serentity prayer. The alternative is that your blood pressure will spike, you will stroke out and that is not fun. (200/ 120) at age 40--now 115/70 at age 60

In the high pressured day when I enoucnter one of these, I have learned to slow down and become almost like a kindergarten teacher so that they can absorb what I am saying.

I sort of wish the patient would have gone to Humongous just so you could have written a referral letter like the ones you get!!

Poor Dr. Grumpy. I heard of a hospice patient who had several really awful things wrong. When awake the patient lay rigid with pain. When offered medicine the patient accepted. The family thought the patient was "too sedated" (they expected the patient to be fully alert and conversational as well as pain free) and so they took the patient to another doctor who agreed and wrote a nasty note saying the patient needed the services of a hospice MD with skills in pain management... The HPM doc was Not Happy. Unrealistic expectations are no fun.

Welcome to my whining!

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